What Is LASIK?

LASIK is a minimally invasive surgical procedure that reduces and in most cases eliminates the dependency on vision assisted appliances such as glasses and contact lenses.

LASIK is an acronym for Laser-Assisted In Situ Keratomileusis and is a procedure that permanently changes the shape of the cornea, the clear covering of the front of the eye, using an excimer laser. A knife, called a microkeratome, is used to cut a flap in the cornea. The flap is folded back revealing the stroma or the middle section of the cornea. Pulses from a computer-controlled laser cut a portion of the stroma and the flap of the cornea is replaced. There are other techniques related to LASIK, some that do not involve cutting.

When is LASIK not for me?

If it jeopardizes your career. Some jobs prohibit certain refractive procedures. Be sure to check with your employer / professional society / military service before undergoing any procedure.

If cost is an issue. Many insurance companies do not cover LASIK. Please check with your provider. You may also apply for financing.

If you had a change in your vision prescription in the past year. This is referred to as refractive instability. Patients who are generally may qualify for refractive instability are:

In their early 20's and younger.

Diabetic and are susceptible to other diseases that lead to fluctuating hormones.

Are pregnant or breastfeeding.

On medications that cause fluctuations in vision.

If you have a disease or are on medications that may affect healing. Certain conditions, like autoimmune diseases such as lupus, rheumatoid arthritis, immunodeficiency states like HIV, diabetes, and some medications such as retinoic acid and steroids may prevent proper healing after a LASIK procedure.

If you actively participate in contact and high impact sports. Boxing, wrestling, martial arts or other activities in which physical contact to the face and eyes are a normal occurrence

If you are under 18. Currently, the LASIK procedure is not recommended on persons under the age of 18.

Precautions

Some patients may experience different effects and have different safety concerns when undergoing LASIK. You should always consult with your doctor if you have a history of any of the following:

Herpes simplex or shingles involving the eye area.

Glaucoma, glaucoma suspect, or ocular hypertension.

Eye diseases, such as uveitis/iritis (inflammations of the eye).

Eye injuries or previous eye surgeries.

Keratoconus.

Other Risk Factors

Your doctor should screen you for the following conditions or indicators of risk:

Blepharitis. Inflammation of the eyelids with crusting of the eyelashes, that may increase the risk of infection or inflammation of the cornea after LASIK.

Large pupils. It is common for many people to have large pupils, younger patients and patients on certain medications may be particularly prone to having large pupils under dim lighting conditions. This can cause symptoms such as glare, halos, starbursts, and double vision after surgery. In some patients these symptoms may be overall detrimental; a patient may no longer be able to drive a car at night or in certain weather conditions.

Thin Corneas. The cornea is the thin clear covering of the eye that is over the iris; the colored part of the eye. LASIK changes the eye's focusing power by reshaping the cornea. Performing a refractive procedure on a cornea that is too thin may result in blinding complications.

Previous refractive surgery such as RK, PRK and LASIK. Additional LASIK may not be recommended. The decision to have additional LASIK must be made in consultation with your doctor after careful consideration of your unique situation.

Dry Eyes. LASIK can aggravate this condition.

What are the risks and how can I find the right doctor for me?

Some patients lose vision.

Some patients can develop glare, halos, or double vision that can greatly impair vision at night.

It is possible that full vision will not be restored. Some patients still need reading glasses or weak prescription lenses.

Some patients report severe cases of dry eyes after surgery.

Results generally depend on the severity of the eyesight. It is possible that a person with severe eyesight to not gain 20/20 vision after surgery.

Some farsighted patients may experience diminishing eyesight with age.

LASIK is a new technology. There is no long term data.

Additional Risks if you are considering the Following:

Monovision
Monovision is a technique used to deal with presbyopia; when the eye gradually loses the ability to change focus from far to close up-usually a result of aging. The idea behind monovision is for the presbyopic patient to use one eye for viewing distances and the other eye for viewing close up. Since one eye is corrected for viewing far and the other eye is corrected for viewing close up, the two eyes no longer work in unison. The results are poor vision quality and decreased depth perception. Monovision is most noticeable in low light and tasks that require sharp vision. In most cases, you will need to wear glasses or contact lenses to fully correct both eyes for viewing far distances or close up when performing tasks that require a sharp eye, such as driving at night, operating machinery, or performing tasks that require sharp vision.

Most patients have a hard time with having one eye blurred at all times. If you are considering monovision with LASIK, it is highly recommended that you go through a trial period with contact lenses to see if monovision can be tolerated. Different states also have specific requirements for driving with monovision.

Another thing to consider is how much your presbyopia is expected to increase over time. Your doctor should be able to tell you when you can expect your monovision surgery to no longer be enough for you to see near-by objects effectively without the aid of glasses or contacts, or when a second surgery might be required to further correct your near vision.

Bilateral Simultaneous Treatment
In most cases patients choose to have surgery on both eyes at the same time, however the practice of having surgery on both eyes is actually riskier.

The advantage of having surgery on one eye at a time is to see how effective the surgery is on the eye and the resulting vision. Also by doing both eyes simultaneously there's a chance that vision in both eyes will be blurry during recovery and may not be able to see for a few days until both eyes heal.

Finding the Right Doctor

Compare.
Always get a second opinion. Some doctors have more or less experience with newer and older technologies. The results from LASIK vary with every little detail, from the individual patient, to the doctor, to the procedure being performed and even the equipment being used.

Cost

Never compromise your health and well being over cost. This applies across the board with all medical related procedures. Eye surgery is permanent and irreversible.

No Guarantees. Be aware of false advertising, faulty promises or package deals. There are never any guarantees in medicine. Do your research.

What should I expect before, during, and after surgery?

What to expect before, during, and after surgery will varies from the individual and the doctor. This section is a compilation of patient information developed by manufacturers and healthcare professionals, but is not a replacement of the consultation that you will have with your doctor. Read this information thoroughly and make sure to discuss your expectations with your doctor.

Before Surgery

Make sure you have a consultation and evaluation with your doctor first.

It is recommended that you stop wearing contact lenses before your evaluation and switch to wearing your glasses full-time. Contact lenses can change the shape of your cornea for weeks after you have stopped using them depending on the type of contact lenses you wear. If your cornea does not assume its natural state before surgery it can lead to negative consequences; including inaccurate measurements and surgical plan, resulting in poor vision after surgery. These measurements, which determine how much corneal tissue to remove, may need to be repeated at least a week after your initial evaluation and before surgery to make sure they have not changed. This is especially true for those who wear RGP or hard lenses.

Soft contact lenses should not be worn 2 weeks before the initial evaluation.

Toric soft lenses or Rigid Gas Permeable (RGP) lenses should not be worn for at least 3 weeks before the initial evaluation.

Hard lenses should not be worn for at least 4 weeks before the initial evaluation.

You should tell your doctor:

about any current or past medical and eye conditions

about any medications being taken, including over-the-counter medications and any medications you may be allergic to

Your doctor should perform a thorough eye exam and discuss:

whether you are a good candidate

what the risks, benefits, and alternatives of the surgery are

what you should expect before, during, and after surgery

what your responsibilities will be before, during, and after surgery

During the consultation you should ask your doctor all the questions you feel you need to ask. Discuss the risks and benefits, review any informational literature provided by your doctor, and make sure all your questions are answered before signing anything.

You should never feel pressured by your doctor, family, friends, or anyone else to make a decision about having surgery. It is your health and well being. It is your decision.

The day before surgery, you should stop using creams, lotions, makeup, and perfumes. These products along with other debris on the eyelashes can increase the risk of infection during and after surgery.

Arrange for transportation to and from your surgery and your first follow-up visit. On the day of surgery, your doctor may give you medication that may impair your ability to drive and see clearly.

During Surgery

The surgery is generally no more than 30 minutes. The surgery takes place in a reclining chair in an exam room where the laser is housed.

Anesthetic eye drops will be placed in your eye and the area around your eye will be cleaned while the lid speculum holds your eyelids open. A ring is then placed on your eye and suction will be applied to the cornea. During suction your vision will dim and you may feel pressure and experience some discomfort. A cutting instrument called the microkeratome, is then attached to the suction ring and the doctor will cut a flap in your cornea.

Afterwards the microkeratome and the suction ring are removed. At this point you will experience fluctuating degrees of blurred vision during the rest of the procedure. The doctor will then lift the flap and fold it back on its hinge, and dry the exposed tissue.

Once the laser is positioned over the eye, you will be asked to stare at a light. The light is not the laser; it's to help you keep your eye fixed in one position so the laser can do its job. If you are unable to stare on a fixed point for no more than 60 seconds you may not be a good candidate for LASIK.

The pulse of the laser makes a ticking, or crackling sound. As the laser removes corneal tissue, you may experience a burning smell. Once the laser is done removing tissue the corneal flap is put back into place.

Your doctor should provide you with a shield to be placed over your eye at the end of the procedure as protection; since there are no stitches used to hold the flap in place. This shield should be worn at night especially to prevent rubbing or putting any kind of pressure on your eye during sleep. You don't want to accidentally hit or poke the flap while it's still healing.

After Surgery

Following the procedure you may experience burning, itching and discomfort as well as mild pain. Your eyes may tear or water and in most cases your vision will be a bit blurry. Remember not to rub your eye, you might move the corneal flap before it heals which will lead to further treatment. You may also experience sensitivity to light, see glare and halos around lights. However in most cases these symptoms improve a few days after surgery. If you work, you should plan on taking a few days off, the recovery time may impair tasks. If you experience severe pain or your vision gets worse, you should immediately see your doctor.

Your first visit to the doctor after surgery should be within the next 24 to 48 hours and at regular intervals afterwards for the next six months. At the first post operative visit your doctor will remove the eye shield, test your vision and examine your eye. At this time your doctor may give you one or more different kinds of eye drops to take home to help prevent infection and inflammation.

Your doctor will advise you to stay away from lotions, creams and make-up around the eye for a few weeks, along with continued scrubbing of your eyelashes. For continued safety, swimming, hot tubs and contact sports should be refrained from for a few months, it is very important to keep your eye safe from any kind of collision. Your doctor should be able to tell you when it is safe to resume these activities.

During the first few months after surgery, your vision may fluctuate. It may take up to anywhere between three to six months for your vision to stabilize after surgery. Glare, halos, difficulty driving at night, and other visual symptoms may also persist during this stabilization period.

Immediately contact your eye doctor if you develop any new, unusual or worsening symptoms at any point after surgery. Such symptoms could signal a problem that may lead to a loss of vision.

LASIK Surgery Checklist (provided by the FDA)

Know what makes you a poor candidate

Career impact - does your job prohibit LASIK?

Cost - can you realistically afford this procedure?

Medical conditions - do you have an autoimmune disease or other major illness? Do you have a chronic illness that might slow or alter healing?

Eye conditions - do you have or have you ever had problems with your eyes other than needing glasses or contacts?

Medications - do you take steroids or other drugs that might prevent healing?

Stable refraction - has your prescription changed in the last year?

High or Low refractive error - do you use glasses/contacts only some of the time? Do you need an unusually strong prescription?

Pupil size - are your pupils extra large in dim conditions?

Corneal thickness - do you have thin corneas?

Tear production - do you have dry eyes?

Know all the risks and procedure limitations

Overtreatment or undertreatment - are you willing and able to have more than one surgery to get the desired result?

May still need reading glasses - do you have presbyopia?

Results may not be lasting - do you think this is the last correction you will ever need? Do you realize that long-term results are not known?

May permanently lose vision - do you know some patients may lose some vision or experience blindness?

Dry eyes-do you know that if you have dry eyes they could become worse, or if you don't have dry eyes before you could develop chronic dry eyes as a result of surgery?

Development of visual symptoms - do you know about glare, halos, starbursts, etc. and that night driving might be difficult?

Contrast sensitivity - do you know your vision could be significantly reduced in dim light conditions?

Bilateral treatment - do you know the additional risks of having both eyes treated at the same time?

Patient information - have you read the patient information booklet about the laser being used for your procedure?

Know how to find the right doctor

Experienced - how many eyes has your doctor performed LASIK surgery on with the same laser?

Equipment - does your doctor use an FDA-approved laser for the procedure you need? Does your doctor use each microkeratome blade only once?

Informative - is your doctor willing to spend the time to answer all your questions?

Long-term Care - does your doctor encourage follow-up and management of you as a patient? Your preop and postop care may be provided by a doctor other than the surgeon.

Be Comfortable - do you feel you know your doctor and are comfortable with an equal exchange of information?

Know preoperative, operative, and postoperative expectations

No contact lenses prior to evaluation and surgery - can you go for an extended period of time without wearing contact lenses?

Have a thorough exam - have you arranged not to drive or work after the exam?

Read and understand the informed consent - has your doctor given you an informed consent form to take home and answered all your questions?

No makeup before surgery - can you go 24-36 hours without makeup prior to surgery?

Arrange for transportation - can someone drive you home after surgery?

Plan to take a few days to recover - can you take time off to take it easy for a couple of days if necessary?

Expect not to see clearly for a few days - do you know you will not see clearly immediately?

Know sights, smells, sounds of surgery - has your doctor made you feel comfortable with the actual steps of the procedure?

Be prepared to take drops/medications- are you willing and able to put drops in your eyes at regular intervals?

Be prepared to wear an eye shield - do you know you need to protect the eye for a period of time after surgery to avoid injury?

Expect some pain/discomfort - do you know how much pain to expect?

Know when to seek help - do you understand what problems could occur and when to seek medical intervention?

Know when to expect your vision to stop changing - are you aware that final results could take months?

Make sure your refraction is stable before any further surgery - if you don't get the desired result, do you know not to have an enhancement until the prescription stops changing?

What Is Custom LASIK or Wavefront LASIK?

Custom LASIK is also known as Wavefront LASIK or more precisely Wavefront Guided LASIK. It reshapes the cornea by using three dimensional measurements of how your eye processes images to guide the laser. This provides a precise and individualized vision experience that would be otherwise impossible to achieve with traditional LASIK.

The FDA has very strict guidelines to follow in order to qualify for custom Wavefront LASIK. Factoring in the different available lasers and the thickness of your cornea, you could be considered a candidate even if you have myopia, hyperopia and astigmatism.

Refractive Surgery

The irregularities in the way your eye processes images are used to guide the laser in the custom shaping of the corneal surface. The irregularities are measured by creating a three dimensional map from the way your eye focuses light.

Prior to Custom or Wavefront LASIK, ordinary defects like myopia, hyperopia and astigmatism were corrected with glasses, contacts or traditional LASIK. However, irregularities associated with the eyes' perceived vision such as glare, halos and poor vision at night could not be addressed

What Are The Benefits of Wavefront-Guided Custom LASIK?

Many of the concerns surrounding LASIK are the post LASIK complications that may occur, such as glare, halos and difficulty seeing at night, which is why Wavefront technology is cutting-edge. It not only has the potential to improve your vision based on the standard 20/20 chart, but has the potential to improve the fine details and better contrast.

Lower-order aberrations or small defects such as myopia, hyperopia and astigmatism can determine how much you can see. These defects can be treated with traditional LASIK.

Higher-order aberrations or a measure of visual distortions more severe than normal vision problems that cause decreased vision at night, glare, shadows and halos cannot be treated with traditional LASIK and are sometimes a side effect of traditional LASIK. Thus the amount of higher-order aberrations determines how well you see. Wavefront LASIK can address these higher-order aberrations.

Wavefront LASIK has the advantage of offering a higher quality of vision and not just a measure of how much you can see. On top of being able to achieve 20/20 or better vision, there is a reduced chance of losing visual quality such as contrast sensitivity, vision at night and distorted vision effects such as halos and glares.

Wavefront LASIK is also ideal for those who have had vision correction procedures done already and have since lost the corrected vision, from previous LASIK, PRK and RK procedures.

How Does Wavefront LASIK Work?

The Wavefront laser safely emits a light into the eye where it maps out a visual pattern of your lower and higher-order aberrations. This pattern is displayed as a three dimensional map, known as a Wavefront map. This map allows the surgeon to customize the LASIK procedure to the unique pattern that is associated with your eye, giving you a customized procedure.

Where can I get Wavefront-Guided Custom LASIK?

Although the cost of traditional LASIK procedures has gone down significantly over the years, Wavefront Guided Custom LASIK is still more expensive than traditional LASIK. Fortunately more and more practices are offering Wavefront or Custom LASIK.

Currently Wavefront LASIK cannot address high myopia and presbyopia; the eyes' inability to focus between different vision planes, such as far, middle and near.

Wavefront LASIK isn't the end all be all procedure. Remember to discuss all procedures and vision related issues with a doctor to determine if you are a candidate for Wavefront or any other LASIK procedure.

Why should I consider having All-Laser LASIK with the FEMTO LDV?

Conventional LASIK is a very safe, effective procedure. In fact, millions of patients have been treated with the traditional approach and technology. While the chance for complications performing conventional LASIK are extremely rare, all surgery carries some degree of risk. With Ziemer's FEMTO LDV all-laser LASIK technology, Dr. Miller now has the technology to achieve impeccable accuracy and control over the first step of LASIK procedure-creating the corneal flap.

How is All-Laser LASIK better than conventional LASIK?

Laser vision correction is a two-step procedure. The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber, providing most of an eye's optical power. It is about "11 hairs" thick. LASIK surgery begins by creating a thin corneal flap of approximately 3 hairs thickness. During the second step of the LASIK procedure, precise and controlled removal of corneal tissue by a special laser reshapes the cornea changing its focusing power and improving vision. The flap is then laid back in position. LASIK is generally painless and recovery is rapid.

Surgeons have traditionally used a microkeratome to create the flap in the cornea. A microkeratome is a hand held mechanical device that has a metal blade which moves across the eye in a controlled fashion and cuts the thin flap in the cornea. Although microkeratomes are very safe in the hands of a surgeon, they can cause complications in 1 in 1000 to 2000 cases.

Using computer-guided technology, The FEMTO LDV creates the flap in the cornea using a laser instead of a blade. Guided by the surgeon, the technology is able to create a flap in the cornea of near perfect proportions with very little deviation from the intended flap thickness.

Is the FEMTO LDV new?

The FEMTO LDV was approved by the FDA early in 2006. Manufactured by Swiss-based Ziemer Group, the FEMTO LDV was first introduced in Europe. It is the most advanced all-laser LASIK procedure available to date!

How would you compare visual improvements using the FEMTO LDV with those of conventional LASIK?

Is All-Laser LASIK more expensive?

Progressive technologies are more expensive for surgeons to offer. Some patients feel that the added level of security is worth the additional fee when considering the LASIK procedure. The choice is yours.